11 - NHPs for MSK conditions Flashcards
Which NHPs are used to reduce symptoms of RA?
- omega 3 fatty acids
- gamma linolenic acid
Which NHPs are used to reduce symptoms of OA?
glucosamine, chondroitin, turmeric, MSM, SAMe
What is rheumatoid arthritis ?
- Autoimmune disorder
- Immune system attacks joints and they are eventually weakened
- Fingers and wrists
- Usually symmetrical
- Pain and inflammation
What is osteoarthritis ?
- Wear and tear
- Overuse of joints/age
- Hands, knees, hips, and spine
- Not usually symmetrical
- Pain and inflammation in severe cases
What NHPs are possibly effective for RA?
- borage
- cats claw
- fish oil
What NHPs have insufficient evidence for RA?
- bromelain
- collagen type 2
- evening primrose oil
- krill oil
- new zealand green lipped mussel
- turmeric
Do we use Thunder God Vine?
No - serious side effects
What is Fish oil also known as?
- omega 3
- PUFA (poly unsaturated fatty acids)
- EPA
- DHA
Is fish oil effective for RA?
may be effective as add on therapy to DMARD
What is gamma linolenic acid found in?
- borage oil
- black currant
- evening primrose oil
Main interaction with GLA’s
warfarin
Is GLA effective in RA?
(evening primrose oil, borage, black current)
-probably may improve pain, may improve function
What are the most common NHPs used for OA?
- glucosamine
- chondroitin
- vitamin supplements
- shark cartilage
- apple cider vinegar
- garlic
MOA of glucosamine for OA?
is a precursor to glycosaminoglycans and proteoglycans that make up articular cartilage
Is glucosamine effective for OA?
insufficient reliable evidence to rate
What is the primary outcome of glucosamine?
decrease worsening of cartilage damage
What is the secondary outcome of glucosamine?
change in bone marrow lesions (BML), decrease in self reported pain
Do we recommend glucosamine?
No - no evidence man
What are some contraindications to glucosamine?
- shellfish allergy
- diabetes
- avoid in pregnancy
- asthma - several case reports
- not studied in renal or hepatic impairments !!
SE of glucosamine
GI upset
Drug interactions with glucosamine
warfarin
MOA of chondroitin for OA
may prevent cartilage metabolism
Drug interactions with chondroitin
theoretically may prolong bleeding times due to structural similarity to heparin
What were the results of GAIT (glucosamien/chondroitin arthritis intervention trial) ?
- reduced knee pain compared to placebo
- rate of response was better for moderate-severe pain group
Does collagen apply to RA or OA?
RA
Evidence of collagen ?
insufficient evidence
Evidence for hyaluronic acid?
insufficient evidence but is for when given by intra-articular injections
Is turmeric effective?
possibly
MOA of turmeric?
may reduce inflammation by inhibiting COX-2 PGs, leukotrienes, and other cytokines involved in pro inflammatory signalling pathways
Why is turmeric a caution with diabetes?
curcumin, can reduce levels of blood glucose and glycosylated hemoglobin in diabetics
What is celedrin and is it effective?
- possibly effective
- may inhibit COX and 5-LO
- may be a joint lubricant
Is MSM effective?
-possibly effective
Possible MOA of MSM
- inhibit degenerative changes in joints
- scavenge hydroxyl free radicals which trigger inflammation
What does SAMe do?
help alleviate osteoarthritis pain
SAMe effective in OA?
likely
Describe eggshell membrane
- promoted for relieving joint pain in as little as 7-10 days
- is a natural source of collage, glucosamine, chondroitin and hyaluronic acid
